Comparison of Laryngeal Mask Airway-Supreme and Endo- tracheal Tube in Adult Patients Undergoing Laparoscopic Surgery

Background: The Laryngeal Mask Airway-Supreme is a supraglottic device with an improved airwayseal and a drainage tube to protect against regurgitation and to facilitate passage of a gastric tube. Purpose: To compare LMA-Supreme™ (LMAS) with the endotracheal tube as regard pulmonary ventilation and gastric distension during laparoscopic surgery. Methods: Eighty ASA I-II patients scheduled for elective laparoscopic surgeries were randomly assigned to LMA-Supreme and ETT for airway management and intraoperative ventilation. After induction of general anesthesia, devices were inserted, correct placement was verified, airway leak was noted, and a gastric tube was inserted. Ease of insertion, quality of airway seal, risk of gastric insufflation, ventilatory capability, and hemodynamic responses were investigated. Anesthesia was maintained with sevoflurane and oxygen, cisatracurium and fentanyl. Results: Placement of a gastric tube was successful in all patients. No gastric distension or signs of regurgitation were detected in both groups. Ventilation parameters and airway pressure during insufflation for LMAS and ETT were comparable. The number of attempts for successful insertion was similar but effective airway time was shorter for LMAS (22.4±13.9 versus 30.1±16.5 sec). Both devices were successfully inserted within three attempts. No episode of failed ventilation or hypoxia was recorded. The hemodynamic responses to insertion and removal were greater for the ETT than LMAS. Gastric size was similar at the start and end of surgery. The frequency of complications was more with ETT. Conclusion: Positive pressure ventilation with a correctly placed and appropriately sized LMA-Supreme allows adequate pulmonary ventilation, without a clinically significant gastric distension and/or adverse actions.